Provider Demographics
NPI:1346530698
Name:PINKERTON, PAULA C (BA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:C
Last Name:PINKERTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:CHRISTINE
Other - Last Name:RIEDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AS
Mailing Address - Street 1:1955 US1 SOUTH
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5786
Mailing Address - Country:US
Mailing Address - Phone:904-209-6001
Mailing Address - Fax:904-209-6002
Practice Address - Street 1:1955 US1 SOUTH
Practice Address - Street 2:SUITE C-2
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5786
Practice Address - Country:US
Practice Address - Phone:904-209-6001
Practice Address - Fax:904-209-6002
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst